Poland Syndrome

If the patient is lucky enough to have had the diagnosis made by the pediatrician, then developmental changes and abnormalities are not unexpected. Often, as the child begins to develop, one breast becomes much larger than the other. First one must consider whether in fact this patient does have Poland syndrome. Many young girls will develop differently on each side of their chest. There are two issues, the first is when to react, and the second is how to react. A child with Poland syndrome is likely to be very self-conscious of her appearance and this may interfere with participating in activities such as gym or going to summer camp. Additionally, this will affect how the child will dress. While it’s generally preferable to wait until the child has fully developed before beginning any correction, there are some situations that require intervention sooner. If the child is suffering and not interacting with others in a normal way then sometimes placing an implant beneath the smaller breast may give this child the self-confidence she needs to interact normally. This is done knowing full well that this implant may not be the right size in the long term and may need replacement or additional procedures later on.

Although flap reconstruction is a great option for Poland syndrome correction, many patients who have only a small to moderate size discrepancy in the breasts do quite well with a breast implant. There are some patients whose deformity is not suited for an implant, and in those patients, a flap would be most appropriate. There are patients who have had multiple implants over the years and would like something that does not require ongoing maintenance. In those patients, a flap would also be appropriate. Young patients rarely will have enough abdominal tissue to perform a DIEP or SIEA flap. While a GAP, TUG, or PAP flap is sometimes done, the geometry and thickness will determine if these will be an option.

If the patient has enough abdominal tissue in order to make the appropriate breast, then the DIEP flap is clearly an option. In fact, not putting any further foreign material in that breast which is already scarred will give the best reconstruction for this patient.

Generally, the rib and chest deformities are not a problem with either flap or implant breast reconstruction. Each individual however, must be evaluated to determine if it is wise and safe to proceed. Most patients with Poland syndrome are missing some or all of their pectoralis major muscle. This is the main muscle on the chest. If there is only a small amount of overlying breast tissue, then implant reconstruction may not be desirable. Absence of a portion or the complete pectoralis muscle is not a problem for successful breast reconstruction with an autologous tissue flaps.